腹腔镜下猪胰肠吻合的学习曲线分析

Analysis on Learning Curve of Laparoscopic Pancreaticojejunostomy in Pigs

目的：评价腹腔镜下猪胰肠吻合的手术效果，探讨其学习曲线。方法2012年9月～2013年2月我科由同一手术团队完成40头家猪腹腔镜下胰肠吻合手术，按家猪实验的时间顺序分为4组（Ⅰ、Ⅱ、Ⅲ、Ⅳ组），每组10例，比较4组手术时间、吻合效果。结果40头家猪腹腔镜下胰肠吻合手术均成功完成。4组手术时间有统计学差异，其中Ⅳ组手术时间（112．7±8．3）min显著短于Ⅰ组（145．1±16．6）min（q＝9．154，P＜0．05）、Ⅱ组（133．0±8．7）min（q＝5．735，P＜0．05）、Ⅲ组（137．2±9．0）min（q＝6．922，P＜0．05），Ⅱ组与Ⅰ组手术时间无统计学差异（q＝3．419，P＞0．05），其他各组间手术时间无统计学差异，表明腹腔镜下猪胰肠吻合的学习曲线约为30例，手术频数约为6．7例／月。4组吻合效果无统计学差异（χ2＝0．586，P＝0．900）。结论腹腔镜下猪胰肠吻合动物实验是可行的，学习曲线约为30例。

Objective To evaluate the surgical effects of laparoscopic pancreaticojejunostomy in pigs and investigate the learning curve. Methods A total of 40 porcine cases of laparoscopic pancreaticojejunostomy were performed by a single surgical team from September 2012 to February 2013.According to the operation sequence, pigs were divided into 4 groups with 10 in each group.For analyzing the efficacy of surgery in different stages, the operation time and efficacy of anastomoses were compared between these groups. Results The operation was finished successfully in all the 40 cases.There were statistical significances in operation time among the four groups.The group Ⅳ had significant shorter time （112.7 ±8.3） min than those in the group Ⅰ [（145.1 ± 16.6） min, q=9.154, P〈0.05], the groupⅡ[（133.0 ±8.7） min, q=5.735, P〈0.05], and the group Ⅲ[（137.2 ±9.0） min, q=6.922, P〈0.05], respectively.There was no difference between the group Ⅱ and the group Ⅰ in operation time （q=3.419, P〉0.05）, so as to other groups.The results of anastomoses among the four groups were not significantly different （χ2 =0.586,P=0.900）. Conclusions Laparoscopic pancreaticojejunostomy in pigs is feasible.The learning curve of the operation is about 30 cases.